CAJ | 학술논문

目的：探讨不稳定骨盆骨折合并髋臼骨折的治疗策略及临床疗效。方法：2007年1月至2013年6月收治32例不稳定骨盆骨折合并髋臼骨折患者，男18例，女14例；年龄18～62岁，平均38岁。Tile骨盆骨折分型：B1型11例，B2.1型8例，B2.2型7例，C1.1型3例，C1.2型2例，C3型1例。Judet-Letournel髋臼骨折分型：前柱骨折1例，横形骨折8例，横形加后壁骨折6例，“T”形骨折1例，前柱加后半横形骨折5例，双柱骨折11例。早期处理其他合并6.5 h，平均3 h；术中失血450～3200 ml，平均1200 ml。有2例肥胖患者切口发生脂肪液化，换药后愈合，无切口感染病例。1例失访，31例获得随访，随访时间6～42个月，平均23个月。骨盆骨折愈合时间8～18周，平均10.6周。按照Matta和Tornetta的评分标准评价复位情况，优15例，良14例，可1例，差1例。Majeed功能评分为83.65±7.67，优15例，良12例，可4例。髋臼骨折愈合时间8～16周，平均10.2周。采用Matta评定标准评估术后复位质量，优15例，良12例，差4例。按Brooker标准评价异位骨化，Ⅰ度4例，Ⅱ度1例。无股骨头坏死及骨折不愈合发生，5例并有神经损伤者4～6个月后均完全恢复。结论：不稳定骨盆骨折合并髋臼骨折患者早期病情危重，运用损伤控制理念及时抢救生命为主。后期把握手术时机，治疗时髋臼骨折尽量解剖复位，骨盆骨折以重建稳定为主，手术复位顺序先固定骨盆后环，根据病情选择合适的手术入路及固定方式。
목적：탐토불은정골분골절합병관구골절적치료책략급림상료효。방법：2007년1월지2013년6월수치32례불은정골분골절합병관구골절환자，남18례，녀14례；년령18～62세，평균38세。Tile골분골절분형：B1형11례，B2.1형8례，B2.2형7례，C1.1형3례，C1.2형2례，C3형1례。Judet-Letournel관구골절분형：전주골절1례，횡형골절8례，횡형가후벽골절6례，“T”형골절1례，전주가후반횡형골절5례，쌍주골절11례。조기처리기타합병6.5 h，평균3 h；술중실혈450～3200 ml，평균1200 ml。유2례비반환자절구발생지방액화，환약후유합，무절구감염병례。1례실방，31례획득수방，수방시간6～42개월，평균23개월。골분골절유합시간8～18주，평균10.6주。안조Matta화Tornetta적평분표준평개복위정황，우15례，량14례，가1례，차1례。Majeed공능평분위83.65±7.67，우15례，량12례，가4례。관구골절유합시간8～16주，평균10.2주。채용Matta평정표준평고술후복위질량，우15례，량12례，차4례。안Brooker표준평개이위골화，Ⅰ도4례，Ⅱ도1례。무고골두배사급골절불유합발생，5례병유신경손상자4～6개월후균완전회복。결론：불은정골분골절합병관구골절환자조기병정위중，운용손상공제이념급시창구생명위주。후기파악수술시궤，치료시관구골절진량해부복위，골분골절이중건은정위주，수술복위순서선고정골분후배，근거병정선택합괄적수술입로급고정방식。
Objective:To discuss the treatment strategy of acetabular fractures and unstable pelvic fracture of the hip and to evaluate its outcome. Methods:Retrospective analysis of clinical data in 32 patients with unstable pelvic fracture and acetabular fractures from January 2007 to June 2013 were collected. There were 18 males and 14 females aged from 18 to 62 years old(means 38 years old). According to Tile classification of pelvic fracture,11 cases were type B1,8 were type B2.1,7 were type B2.2,3 were type C1.1,2 were type C1.2,1 was type C3. According to Judet-Letournel classification,anterior col?umn fracture was in 1 case,transverse fracture in 8,transverse plus posterior wall fracture in 6,T-type fracture in 1,anterior column plus half transverse fractures in 5,double column fracture in 11. Other combined injuries were treated early,the surgi?cal operation were performed after stable condition. The hip joint function and the fracture reduction were assessed during fol?low up. Results:The operative time was from 1.8 to 6.5 hours(averaged 3 hours). Two fat patients'incision occurred in fat liq?uefaction and healed after dressing,no incision infection happened. Only 1 case was lost to follow up,31 patients were fol?lowed up with a mean time of 23 months(6 to 42 months). The healing time of pelvic fracture was from 8 to 18 weeks(aver?aged in 10.6 weeks). The hip function was evaluated according to the Matta and Tornetta standard postoperatively,the result was excellent in 15 cases,good in 14 cases,fair and poor in 1 case respectively. The Majeed score of the hip function was 83.65±7.67,the result was excellent in 15 cases,good in 12 cases and fair in 4 cases. The healing time of acetabular fractures was from 8 to 16 weeks(averaged in 10.2 weeks). The fracture reduction was assessed by Matta standard,the result was excel?lent in 15 cases,good in 12 cases and fair in 4 cases. The heterotopic ossification was evaluated by Brooker standard,4 cases were gradeⅠ,1 case was gradeⅡ. There were no infection,nonunion and necrosis of the femoral head in all patients. The nerve damage symptoms in 5 patients disappeared during 4 to 6 months after operation. Conclusion:Patients with unstable pelvic fractures and acetabulum fractures were in a critical condition early,using the concept of damage control to save lives in a timely manner. Grasp the operation time in the late treatment,acetabulum fractures reach anatomical reduction as far as possible,pelvic fractures are given priority to stable reconstruction. The operation order was fixed pelvic ring first ,according to the con?dition to choose the appropriate surgical approach and fixed mode.